Pub Date : 2025-02-06DOI: 10.1016/j.ajt.2025.01.045
Syed Shahyan Bakhtiyar, Tiffany E Maksimuk, Michael T Cain, Jordan R H Hoffman
{"title":"Opinions vs. Evidence: Data-Driven Insights into the Organ Yield and Cost of Normothermic Regional Perfusion in Donation After Circulatory Death.","authors":"Syed Shahyan Bakhtiyar, Tiffany E Maksimuk, Michael T Cain, Jordan R H Hoffman","doi":"10.1016/j.ajt.2025.01.045","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.01.045","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-05DOI: 10.1016/j.ajt.2025.02.001
Amit Banga, Christine Hartley, Zeynep Tulu, J W MacArthur, Gundeep Dhillon
In March 2023, the allocation strategy for lung transplantation (LT) underwent significant changes with the introduction of the new system, referred to as the continuous distribution (CD). The current paper describes the early impact of CD implementation on the mechanics of LT at a large tertiary care medical center. This was a retrospective study conducted across nine months before (March 2022 to November 2022) and after (March 2023 to November 2023) the implementation of the CD allocation system. The number of lung donor offers increased by 59% in the post-CD period (p=0.002). The median offers per waitlisted patient increased even more (p<0.001), leading to a significant reduction in time to transplant (p<0.001). Early clinical outcomes (median length of stay and hospital survival) were unchanged, while the cumulative length of index hospitalization was lower by 10% during the post-CD period. The cost/bed-day increased by 4.5% in a post-CD period, which converted to a 32% decrease in the contribution margin per transplant. In conclusion, the implementation of CD was associated with improved access to donor lungs, leading to favorable trends in the time to transplant while maintaining post-transplant outcomes. The CD was associated with a significant jump in the cost of LT.
{"title":"Impact of continuous distribution as the allocation strategy on lung transplantation.","authors":"Amit Banga, Christine Hartley, Zeynep Tulu, J W MacArthur, Gundeep Dhillon","doi":"10.1016/j.ajt.2025.02.001","DOIUrl":"https://doi.org/10.1016/j.ajt.2025.02.001","url":null,"abstract":"<p><p>In March 2023, the allocation strategy for lung transplantation (LT) underwent significant changes with the introduction of the new system, referred to as the continuous distribution (CD). The current paper describes the early impact of CD implementation on the mechanics of LT at a large tertiary care medical center. This was a retrospective study conducted across nine months before (March 2022 to November 2022) and after (March 2023 to November 2023) the implementation of the CD allocation system. The number of lung donor offers increased by 59% in the post-CD period (p=0.002). The median offers per waitlisted patient increased even more (p<0.001), leading to a significant reduction in time to transplant (p<0.001). Early clinical outcomes (median length of stay and hospital survival) were unchanged, while the cumulative length of index hospitalization was lower by 10% during the post-CD period. The cost/bed-day increased by 4.5% in a post-CD period, which converted to a 32% decrease in the contribution margin per transplant. In conclusion, the implementation of CD was associated with improved access to donor lungs, leading to favorable trends in the time to transplant while maintaining post-transplant outcomes. The CD was associated with a significant jump in the cost of LT.</p>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":" ","pages":""},"PeriodicalIF":8.9,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143373660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2025.01.025
Maryam Valapour , Carli J. Lehr , David P. Schladt , Kaitlin Swanner , Kelley Poff , Dzhuliyana Handarova , Samantha Weiss , Chelsea J. Hawkins , Ajay K. Israni , Jon J. Snyder
The year 2023 marked a year of major transition for the lung transplant community in the United States, as it became the first to adopt the continuous distribution system for organ allocation. Starting on March 9, 2023, the composite allocation score (CAS) was used to rank candidates for access to a lung transplant. Shortly after the adoption of this CAS system, it was amended to better represent the biological disadvantage of candidates with blood type O for accessing a donor organ. Despite the challenges of implementing major changes to the system, the year 2023 marked many successes and milestones in US lung transplantation. A total of 3,049 adult lung transplants were performed, representing the most transplants performed in any single year. Transplant rates continued their increase over time and reached an all-time high of 307.6 transplants per 100 patient-years for adults on the waiting list. By 1 year after listing, 81.2% of adult candidates underwent a deceased donor lung transplant, with 62.6% of them having waited 3 months or less. Adult waitlist mortality rates decreased to their lowest at 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality. Survival after lung transplant remained stable over the past decade with 88.5% of adults who underwent transplant in 2022 surviving to 1 year compared with 87.2% of adults who underwent transplant in 2013.
{"title":"OPTN/SRTR 2023 Annual Data Report: Lung","authors":"Maryam Valapour , Carli J. Lehr , David P. Schladt , Kaitlin Swanner , Kelley Poff , Dzhuliyana Handarova , Samantha Weiss , Chelsea J. Hawkins , Ajay K. Israni , Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.025","DOIUrl":"10.1016/j.ajt.2025.01.025","url":null,"abstract":"<div><div>The year 2023 marked a year of major transition for the lung transplant community in the United States, as it became the first to adopt the continuous distribution system for organ allocation. Starting on March 9, 2023, the composite allocation score (CAS) was used to rank candidates for access to a lung transplant. Shortly after the adoption of this CAS system, it was amended to better represent the biological disadvantage of candidates with blood type O for accessing a donor organ. Despite the challenges of implementing major changes to the system, the year 2023 marked many successes and milestones in US lung transplantation. A total of 3,049 adult lung transplants were performed, representing the most transplants performed in any single year. Transplant rates continued their increase over time and reached an all-time high of 307.6 transplants per 100 patient-years for adults on the waiting list. By 1 year after listing, 81.2% of adult candidates underwent a deceased donor lung transplant, with 62.6% of them having waited 3 months or less. Adult waitlist mortality rates decreased to their lowest at 13.3 deaths per 100 patient-years, meeting one of the major goals of the organ allocation systems: to decrease waitlist mortality. Survival after lung transplant remained stable over the past decade with 88.5% of adults who underwent transplant in 2022 surviving to 1 year compared with 87.2% of adults who underwent transplant in 2013.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S422-S489"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2025.01.023
Simon P. Horslen , Vikram K. Raghu , Yoon Son Ahn , Jesse Howell , Benjamin Schumacher , Meghan McDermott , Ajay K. Israni , Jon J. Snyder
Intestine transplant can have significant health and quality-of-life benefits for those who require it. Despite its infrequent use, intestine transplant remains a mainstay of treating those with complications from long-term parenteral nutrition due to intestinal failure, as well as salvage therapy for those with a significant abdominal catastrophe. In 2023, there were 135 candidates added to the intestine transplant waiting list. Those awaiting intestine-without-liver transplant have low mortality on the waiting list, with no reported deaths in 2023. However, 8 patients died awaiting intestine-with-liver transplant, and the estimated 3-year mortality for those listed exceeds 10.0%. A total of 95 intestine transplants were performed in 2023, with only 33 performed in the pediatric age range. However, 18 of 34 recipients of intestine-with-liver transplant were in the pediatric age range. Immunosuppression for intestine transplants most commonly included an induction agent followed by maintenance with a combination of medications that included tacrolimus. In the recipients of intestine-without-liver transplants, 1- and 5-year graft survival were 78.3% and 46.5% in adult and 76.1% and 52.2% in pediatric recipients, respectively. In the recipients of intestine-with-liver transplants, 1- and 5-year graft survival were 57.8% and 45.6% in adult and 81.1% and 60.0% in pediatric recipients, respectively. Acute rejection episodes occurred for approximately 20.0% of patients within the first year. The 5-year cumulative incidence of posttransplant lymphoproliferative disorder was higher in those with an intestine-without-liver transplant (11.5%) compared with those who also received a liver (2.5%). Rates of intestine transplant have remained stable for the past several years, with increasing need in the adult population. Future reports may reflect whether children who have avoided intestine transplant with the recent advances in intestinal rehabilitation ultimately require the procedure in adulthood.
{"title":"OPTN/SRTR 2023 Annual Data Report: Intestine","authors":"Simon P. Horslen , Vikram K. Raghu , Yoon Son Ahn , Jesse Howell , Benjamin Schumacher , Meghan McDermott , Ajay K. Israni , Jon J. Snyder","doi":"10.1016/j.ajt.2025.01.023","DOIUrl":"10.1016/j.ajt.2025.01.023","url":null,"abstract":"<div><div>Intestine transplant can have significant health and quality-of-life benefits for those who require it. Despite its infrequent use, intestine transplant remains a mainstay of treating those with complications from long-term parenteral nutrition due to intestinal failure, as well as salvage therapy for those with a significant abdominal catastrophe. In 2023, there were 135 candidates added to the intestine transplant waiting list. Those awaiting intestine-without-liver transplant have low mortality on the waiting list, with no reported deaths in 2023. However, 8 patients died awaiting intestine-with-liver transplant, and the estimated 3-year mortality for those listed exceeds 10.0%. A total of 95 intestine transplants were performed in 2023, with only 33 performed in the pediatric age range. However, 18 of 34 recipients of intestine-with-liver transplant were in the pediatric age range. Immunosuppression for intestine transplants most commonly included an induction agent followed by maintenance with a combination of medications that included tacrolimus. In the recipients of intestine-without-liver transplants, 1- and 5-year graft survival were 78.3% and 46.5% in adult and 76.1% and 52.2% in pediatric recipients, respectively. In the recipients of intestine-with-liver transplants, 1- and 5-year graft survival were 57.8% and 45.6% in adult and 81.1% and 60.0% in pediatric recipients, respectively. Acute rejection episodes occurred for approximately 20.0% of patients within the first year. The 5-year cumulative incidence of posttransplant lymphoproliferative disorder was higher in those with an intestine-without-liver transplant (11.5%) compared with those who also received a liver (2.5%). Rates of intestine transplant have remained stable for the past several years, with increasing need in the adult population. Future reports may reflect whether children who have avoided intestine transplant with the recent advances in intestinal rehabilitation ultimately require the procedure in adulthood.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages S288-S328"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143386750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2024.08.011
Christian T.J. Magyar , Zhihao Li , Laia Aceituno , Marco P.A.W. Claasen , Tommy Ivanics , Woo Jin Choi , Luckshi Rajendran , Blayne A. Sayed , Roxana Bucur , Nadia Rukavina , Nazia Selzner , Anand Ghanekar , Mark Cattral , Gonzalo Sapisochin
Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. In total, 7257 LDLT recipients with a median age of 54 years (interquartile range [IQR]: 45-61 years), 54% male, 80% non-Hispanic White, body mass index of 26.3 kg/m2 (IQR: 23.2-30.0 kg/m2), and model for end-stage liver disease score of 15 (IQR: 11-19) were included. The median cold ischemic time was 1.6 hours (IQR: 1.0-2.3 hours) with 88% right lobe grafts. The follow-up was 4.0 years (IQR: 1.0-9.2 years). The contemporary reached median OS was 17.0 years (95% CI: 16.1, 18.1 years), with the following OS estimates: 1 year 95%; 3 years 89%; 5 years 84%; 10 years 72%; 15 years 56%; and 20 years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (adjusted hazards ratio: 0.53; 95% CI: 0.39, 0.71). The median center-caseload per year was 5 (IQR: 2-10), with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.
{"title":"Temporal evolution of living donor liver transplantation survival—A United Network for Organ Sharing registry study","authors":"Christian T.J. Magyar , Zhihao Li , Laia Aceituno , Marco P.A.W. Claasen , Tommy Ivanics , Woo Jin Choi , Luckshi Rajendran , Blayne A. Sayed , Roxana Bucur , Nadia Rukavina , Nazia Selzner , Anand Ghanekar , Mark Cattral , Gonzalo Sapisochin","doi":"10.1016/j.ajt.2024.08.011","DOIUrl":"10.1016/j.ajt.2024.08.011","url":null,"abstract":"<div><div>Living donor liver transplantation (LDLT) is a curative treatment for various liver diseases, reducing waitlist times and associated mortality. We aimed to assess the overall survival (OS), identify predictors for mortality, and analyze differences in risk factors over time. Adult patients undergoing LDLT were selected from the United Network for Organ Sharing database from inception (1987) to 2023. The Kaplan-Meier method was used for analysis, and multivariable Cox proportional hazard models were conducted. In total, 7257 LDLT recipients with a median age of 54 years (interquartile range [IQR]: 45-61 years), 54% male, 80% non-Hispanic White, body mass index of 26.3 kg/m<sup>2</sup> (IQR: 23.2-30.0 kg/m<sup>2</sup>), and model for end-stage liver disease score of 15 (IQR: 11-19) were included. The median cold ischemic time was 1.6 hours (IQR: 1.0-2.3 hours) with 88% right lobe grafts. The follow-up was 4.0 years (IQR: 1.0-9.2 years). The contemporary reached median OS was 17.0 years (95% CI: 16.1, 18.1 years), with the following OS estimates: 1 year 95%; 3 years 89%; 5 years 84%; 10 years 72%; 15 years 56%; and 20 years 43%. Nine independent factors associated with mortality were identified, with an independent improved OS in the recent time era (adjusted hazards ratio: 0.53; 95% CI: 0.39, 0.71). The median center-caseload per year was 5 (IQR: 2-10), with observed center-specific improvement of OS. LDLT is a safe procedure with excellent OS. Its efficacy has improved despite an increase of risk parameters, suggesting its limits are yet to be met.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 406-416"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142007900","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2024.09.026
Dima Kabbani , Efrat Orenbuch-Harroch , Carl Boodman , Sarah Broad , Manuel Paz-Infanzon , Sara Belga , Oscar A. Fernández-García , Emily Christie , Majid L.N. Sikosana , Soroush Shojai , Sita Gourishankar , Carlos Cervera , Karen Doucette
Bartonella quintana infection is rarely described to be transmitted through solid organ transplant (SOT). We report a cluster of using donor-derived B quintana infection and the attack rate from Bartonella seropositive donors. In this retrospective study of SOT recipients that received an organ from an unhoused deceased donor (UDD) in Alberta in 2022-2023, serology testing for Bartonella was performed indirect immunofluorescent assay on UDDs and recipients of UDDs with positive serology. Titers ≥1:64 were considered positive. During the study period, 31/32 UDDs were tested for immunoglobulin G to Bartonella (20 negative, 11 positive for B quintana and/or B henselae). Thirty-two organs were transplanted from the 11 seropositive donors. Six SOT recipients developed bartonellosis secondary to B quintana (4 SOT recipients received organs from 3 seropositive donors, and 2 SOT recipients from 1 UDD with no stored sample for testing). The attack rate for clinical disease from positive donors was 12.5% (4/32). The main presentation was skin nodules/papules (median 5.5 months) with bacillary angiomatosis in 4/6. Bartonella serology was positive in 5/6 SOT recipients (initially negative in 2) and blood B quintana quantitative polymerase chain reaction in 1. None had visceral involvement. All donors had history of substance use. This outbreak of bartonellosis reinforces the potential for unexpected donor-transmitted infections. Clinicians should be aware of high transmission of B quintana through transplant from infected UDDs.
{"title":"Donor-derived bartonellosis in solid organ transplant recipients from unhoused donors in Alberta","authors":"Dima Kabbani , Efrat Orenbuch-Harroch , Carl Boodman , Sarah Broad , Manuel Paz-Infanzon , Sara Belga , Oscar A. Fernández-García , Emily Christie , Majid L.N. Sikosana , Soroush Shojai , Sita Gourishankar , Carlos Cervera , Karen Doucette","doi":"10.1016/j.ajt.2024.09.026","DOIUrl":"10.1016/j.ajt.2024.09.026","url":null,"abstract":"<div><div><em>Bartonella quintana</em> infection is rarely described to be transmitted through solid organ transplant (SOT). We report a cluster of using donor-derived <em>B quintana</em> infection and the attack rate from <em>Bartonella</em> seropositive donors. In this retrospective study of SOT recipients that received an organ from an unhoused deceased donor (UDD) in Alberta in 2022-2023, serology testing for <em>Bartonella</em> was performed indirect immunofluorescent assay on UDDs and recipients of UDDs with positive serology. Titers ≥1:64 were considered positive. During the study period, 31/32 UDDs were tested for immunoglobulin G to <em>Bartonella</em> (20 negative, 11 positive for <em>B quintana</em> and/or <em>B henselae</em>). Thirty-two organs were transplanted from the 11 seropositive donors. Six SOT recipients developed bartonellosis secondary to <em>B quintana</em> (4 SOT recipients received organs from 3 seropositive donors, and 2 SOT recipients from 1 UDD with no stored sample for testing). The attack rate for clinical disease from positive donors was 12.5% (4/32). The main presentation was skin nodules/papules (median 5.5 months) with bacillary angiomatosis in 4/6. <em>Bartonella</em> serology was positive in 5/6 SOT recipients (initially negative in 2) and blood <em>B quintana</em> quantitative polymerase chain reaction in 1. None had visceral involvement. All donors had history of substance use. This outbreak of bartonellosis reinforces the potential for unexpected donor-transmitted infections. Clinicians should be aware of high transmission of <em>B quintana</em> through transplant from infected UDDs.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 417-423"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142328849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2024.11.001
Steven A. Wisel , Justin A. Steggerda , Aleah L. Brubaker , Anji Wall , Irene K. Kim
{"title":"Keep the engine running: Maintaining transplant registry utility in liver transplant","authors":"Steven A. Wisel , Justin A. Steggerda , Aleah L. Brubaker , Anji Wall , Irene K. Kim","doi":"10.1016/j.ajt.2024.11.001","DOIUrl":"10.1016/j.ajt.2024.11.001","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 447-448"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142613042","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2024.10.001
Steven Van Laecke, Griet Glorieux
Immunosenescence, the age-related dysregulation of innate and adaptive immunity, impairs immune response and increases inflammation, leading to higher infection and cardiovascular risks, particularly outside the field of transplantation. In kidney transplant recipients (KTRs), conditions like cytomegalovirus infection, old age, uremia, smoking, and diabetes, linked to poor outcomes, are associated with enhanced immunosenescence. Recent studies highlight the pathogenic role of cytotoxic T cells, particularly terminally differentiated effector memory T cells that reexpress CD45RA (TEMRA), in graft dysfunction. A higher proportion of circulating CD8+ TEMRA cells is observed in KTRs with chronic rejection. In antibody-mediated rejection, they invade the graft by superior chemotactic properties and binding to human leukocyte antigen (HLA) antibodies through FcγRIIIa (CD16). Also in microvascular inflammation without donor-specific antibodies, and even in patients without rejection but faster decline of kidney function, intragraft CD8+ TEMRA cells were instrumental. CD8+ TEMRA cells may explain the unresolved dismal graft outcomes associated with donor age and cytomegalovirus-serostatus mismatching and could become a novel therapeutic target in KTRs.
{"title":"Terminally differentiated effector memory T cells in kidney transplant recipients: New crossroads","authors":"Steven Van Laecke, Griet Glorieux","doi":"10.1016/j.ajt.2024.10.001","DOIUrl":"10.1016/j.ajt.2024.10.001","url":null,"abstract":"<div><div>Immunosenescence, the age-related dysregulation of innate and adaptive immunity, impairs immune response and increases inflammation, leading to higher infection and cardiovascular risks, particularly outside the field of transplantation. In kidney transplant recipients (KTRs), conditions like cytomegalovirus infection, old age, uremia, smoking, and diabetes, linked to poor outcomes, are associated with enhanced immunosenescence. Recent studies highlight the pathogenic role of cytotoxic T cells, particularly terminally differentiated effector memory T cells that reexpress CD45RA (T<sub>EMRA</sub>), in graft dysfunction. A higher proportion of circulating CD8<sup>+</sup> T<sub>EMRA</sub> cells is observed in KTRs with chronic rejection. In antibody-mediated rejection, they invade the graft by superior chemotactic properties and binding to human leukocyte antigen (HLA) antibodies through FcγRIIIa (CD16). Also in microvascular inflammation without donor-specific antibodies, and even in patients without rejection but faster decline of kidney function, intragraft CD8<sup>+</sup> T<sub>EMRA</sub> cells were instrumental. CD8<sup>+</sup> T<sub>EMRA</sub> cells may explain the unresolved dismal graft outcomes associated with donor age and cytomegalovirus-serostatus mismatching and could become a novel therapeutic target in KTRs.</div></div>","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 250-258"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142398788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.ajt.2024.09.014
Sanjay Kulkarni , Keren Ladin
{"title":"Ethical implications of prioritizing utility at all costs: The rise of out-of-sequence transplants","authors":"Sanjay Kulkarni , Keren Ladin","doi":"10.1016/j.ajt.2024.09.014","DOIUrl":"10.1016/j.ajt.2024.09.014","url":null,"abstract":"","PeriodicalId":123,"journal":{"name":"American Journal of Transplantation","volume":"25 2","pages":"Pages 232-233"},"PeriodicalIF":8.9,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142273388","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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